Alternative treatment options

Alternative treatment options

There are several treatment options for a single missing tooth; the most common are an implant-supported crown, a 3-unit fixed partial denture supported by two natural teeth, a fixed resin-bonded fixed partial denture, a removable partial denture, orthodontic closure of the open space and no treatment.

Choices are influenced by:

• clinical factors, e.g. condition of remaining dentition, occlusal dimensions, degree of resorption of bone;
• surgeon and dentist factors, e.g. knowledge of treatment possibilities, skillfulness to perform every kind of treatment;
• patient factors, e.g. accessibility to state-of-art dental treatment, dental awareness, the position of the open space (anterior or posterior), anxiety for (surgical) dental procedures, financial aspects.

Implant-supported restorations have a good prognosis, high patient satisfaction, and the advantage that adjacent teeth are not involved in the treatment. Anxiety about surgical treatment, the position of the single-tooth space, and financial aspects may be reasons not to consider an implant-supported crown as first-choice treatment.

Patient expectation management and guidance

Understanding and successfully managing patient expectations is the most important predictor of patient satisfaction. The clinician should listen very carefully and evaluate how a patient expresses demands and how the patient adapts their expectations after hearing what can and cannot be achieved by different treatment options. One should not overpromise treatment possibilities. To that end, during the discussion of treatment options and the key factors associated with each option, the following concepts should be presented to the patient:

• what is possible to achieve and what is not
• prognostic factors
• patient time, treatment times and timelines
• temporary discomfort
• morbidity
• risks and prognostic factors for long-term success
• costs and eventual reimbursements

The occurrence and response to the treatment options discussion must be documented in the patient record including a review of the different treatment options presented. Treatment options have to be discussed with the patient. Different factors may have different levels of importance to the patient, as well as clinically, depending on the missing tooth position.

Figure 1: Missing tooth in position 12 (#7 UNIV)

Figure 2: Missing tooth in position 26 (#14 UNIV)